If you were to find out that there are more
than 35 million people infected with liver fluke, wouldn’t you be worried that
you’re one of them? What makes it even scarier is that these parasites can live
inside our bodies for as long as 20 to 30 years before manifesting through
various symptoms. Even if you are one of the lucky ones whose infection is
asymptomatic, isn’t it unsettling to know that there are wrigglers living
inside you that may cause you pain and sickness any minute? At times, liver
flukes can even cause terminal disease
s
at its late stages. That is what happened to some US Vietnam war veterans who
have been diagnosed with liver flukes and are now suffering from
cholangiocarcinoma or bile duct cancer.

In the past few months, the terms liver
fluke and bile duct cancer have been buzz words following a study by the US
Department of Veterans Affairs (VA). In the blood testing conducted by the
agency, it was found out that more than 20% of the veterans tested are positive
for antibodies against liver flukes. This type of liver fluke epidemic,
however, is quite common in Asian countries. In 2001, for example, a 9.4%
prevalence was reported in Thailand. This meant that over 6 million people were
infected at that time.

In the case of the US veterans though, what
makes it alarming is that about 700 Vietnam veterans have been reported to
suffer from bile duct cancer in the past 15 years. This type of cancer is
supposedly rare in developed and western countries, with only 7 casualties for
every 1 million people. In the US alone, as many as 8,000 people are diagnosed
with bile duct cancer yearly. Among the diagnosed cases, a few are said to be
caused by liver flukes.

What
are liver flukes?

Liver flukes are flat, leaf-like parasites
measuring 8-10 mm as adults. That’s 5/16 to 3/8 of an inch. They cause inflammation
and dilation of the bile ducts and also thickening of the bile duct walls.
Flukes can be ingested through the consumption of fluke-infested, uncooked
fish, watercress, or other fresh water animals (like snails, frogs, and
mussels). Infection can also be initiated if water contaminated by cattle or
sheep excrements will be used for cooking or drinking. Liver flukes may be
found anywhere on the globe but they are most common in Asia and in Eastern
Europe. This includes countries like northern Thailand, Southern China,
Manchuria, and most recently – Vietnam, with as much as 75% of the population
infected.

There are three most well-known species of
liver flukes that cause human infection. These are
Clonorchis sinensis, Opisthorchis
viverrini
and Opisthorchis felineus, causing
clonorchiasis and opisthorchiasis respectively.These infections are often diagnosed through complete blood count
(CBC) tests and by checking antibody levels for the parasite. Stool examination
and imaging tests like ultrasound, CT-scan, MRI, and ERCP may be done.

Oftentimes, liver fluke infection is asymptomatic
and some people can live full lives in spite of the existing parasitic
infestation. In others, symptoms do manifest including abdominal pain, nausea,
fever, diarrhea, hives, and loss of appetite. Jaundice may also occur if the
sheer multitude of flukes in the bile ducts is already blocking the bile flow.

There are a number of complications caused
by liver flukes:

1.Recurrent Pyogenic Cholangitis
– Acute suppurative (i.e. pus-producing) cholangitis (inflammation of the bile ducts)
may happen when the bile ducts are blocked by masses of dead worms, ova, and
mucin. This can be aggravated by the decreased bile flow caused by the
abundance of the parasites and their excretion.

2.Gallstone and Bile Duct Stone
Formation – Bile duct stones can be the consequence of bile stagnation due to
the obstruction of the ducts. Bilirubin stones can also form as the bilirubin
undergoes a number of mechanical and chemical changes during cholangitis (bile
duct inflammation).

3.Cholangiohepatitis –
inflammation of the liver and bile ducts

4. Fluke infection in various parts of the body
such as the brain, the liver, lymph nodes, skin, or spinal cord.

5.Gallbladder perforation

6.Pancreatitis

7.Bile Duct Cancer

Bile
Duct Cancer

Bile duct cancer or cholangiocarcinoma is a
rare type of cancer that affects the biliary system. It is commonly associated
with
Clonorchis sinensis and Opisthorchis viverrini. Bile duct cancer
is considered very difficult to diagnose and treat due to its wide variation
and the rarity of the condition. It also usually presents in its late stages,
increasing the risk of mortality.

Three
types of cholangiocarcinoma

Intrahepatic - which forms in
the bile ducts within the liver

Extrahepatic - also called
distal bile duct cancer

Perihilar bile duct cancer –
forms at the point where the hepatic ducts join together to exit the liver

Symptoms
of cholangiocarcinoma

Jaundice

Pale stools

Dark urine

Pruritus

Malaise

Nausea and vomiting

Abdominal pain

Weight loss

Other symptoms depending on the
infection type, location of tumour, and the susceptibility of the individual

Other risk factors for bile duct cancer
include the following:

Chronic ulcerative colitis

Primary sclerosing cholangitis
or PSC

Cysts in the bile ducts

Cirrhosis of the liver

Hepatitis B or C virus

Diabetes

Obesity

Genetic factors

Liver
Flukes and Bile Duct Cancer

There are various ways in which liver fluke
infection can escalate to bile duct cancer. One is through mechanical injury
from the feeding and migration of the flukes combined with the excrement. The
tissue damage and scarring caused by the suckers of the fluke hook as well as
its other activities can lead to bile duct cancer. Secondly, the persistent
inflammation and/or prolonged infection with liver fluke may contribute to the development
of cholangiocarcinoma. Biliary cell damage can also be induced by the liver
flukes through the actions of oxygen radicals causing oxidative DNA damage to
the biliary system.

Liver
Fluke Prevention

Liver flukes are not prevalent in developed
countries but it is still better to be safe than sorry. Prevention is extremely
important, especially while travelling or consuming unfamiliar food.

Since
C. sinensis and O. viverrini are acquired through
ingestion, make sure that your drinking water is treated or boiled, especially
when traveling in the countryside. If uncertain, it is better to purchase
sealed distilled water bottles that guarantee your safety. Aside from being
wary of the liquids you intake, it is important to be cautious about the food
you eat. Even vegetables grown and drawn near infested areas can be carriers.

It is always best if you cook your
food at home. But at times when you can’t, avoid consuming raw food especially
animal liver and fish. Also choose reputable eating places so you can at least
be confident about their food handling and safety during preparation and
serving. And on the topic of cleanliness, washing your hands with soap and
clean water always goes a long way.

Liver
Flukes Diagnosis and Treatment

So what do you do if you already are
infected with liver fluke? Nothing beats regular consultation with a medical
practitioner. With that, you can have the peace of mind that your condition is
being monitored. The infection in itself is not fatal but complications arising
from it can be. So upon discussion with your doctor, you may be given the
following treatment options:

1.Medication – Some
pharmaceutical drugs such as triclabendazole, praziquantel and tribendimidine may be prescribed for 2-7
days, depending on the dosage. After the medication, stool examination will be
repeated and patients will be recommended for retreatment if infection is still
present.

2.Alternative treatment – There are a few alternative
treatments for those suffering from liver flukes. Examples are colonic
irrigation, parasite cleanses, golden seal, natural liver fluke detox formulas,
bowel cleaners such as Premier Cleanse, and bile movers like Herbal Digestive
Bitters and Beet Capsules. A word of caution though, it is best to consult your
doctor before taking any supplements or doing these treatments to make sure
that it does not counteract any medications you are taking or that it will not
worsen any other physical condition you may have.

3.
Paratosin - This
botanical blend provides gastrointestinal and immune support for patients with
liver fluke as well as other related parasitic infections.

4.BiliVen- BiliVen is purported to expand the bile ducts to allow for easier exit of the flukes as well as offering general gallbladder and bile support.

Causes of Gallbladder Disease

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